Neurological testing apparatus

ABSTRACT

An apparatus for performing neuropsychological tests on a patient includes a microprocessing unit adapted for carrying out test procedures which is connected to an interface to a sensory signal generating device comprising at least one of a visual information display, an indication light, and a sound generator, an interface to a reaction detecting device comprising at least one of a dynamometer, a knob, and a touch screen, and an interface to a memory for reading test procedures stored in the memory. At least one test procedure comprising instructions for the generation of sensory signals and the detection of a patient reaction is stored in the memory and is performed by generating the sensory signals on the sensory generating device and by detecting a patient&#39;s reaction through the reaction detecting device.

This application is a continuation of prior application Ser. No.09/678,104 filed Oct. 4, 2000, now U.S. Pat. No. 6,517,480, which ishereby incorporated by reference.

FIELD OF THE INVENTION

The present invention concerns an apparatus for measuringneuro-cognitive activity by carrying out neuropsychological tests, inparticular for testing impairments and competencies relating toneuropsychological function.

DESCRIPTION OF THE PRIOR ART

Neuropsychological tests are used by doctors to measure underlyingperceptual, cognitive, and information processing abilities, and inparticular, assess deficits or changes in attention, immediate and shortterm memory, visual-perceptual functions, sequencing functions, logicalproblem solving, calculation skills, reaction time, simultaneousinformation processing abilities, and executive functioning. Apparatusesare known which measure only a few patient functions such as reactiontime. However, in the known apparatuses, other patient functions are nottested, so that only a very narrow and imprecise assessment of thepatient's abilities is possible based on this type of tests.

SUMMARY OF THE INVENTION

A purpose of the present invention is to provide an apparatus forcarrying out neuropsychological tests which enables assessment of a widevariety of neurocognitive areas.

Accordingly, in a first aspect of the present invention, an apparatusfor performing neuropsychological tests on a patient comprises:

means for generating a plurality of sensory signals comprising visualsignals, auditory signals, or both visual and auditory signals; and

means for detecting physical movement of a patient in response to saidgenerated plurality of sensory signals.

Advantageously, the plurality of sensory signals is determined prior toperforming a test on a patient. Visual signals and auditory signals maybe simultaneously generated. The apparatus may further comprise one orseveral additional means such as means for storing, processing, or bothstoring and processing information obtained from the means for detectingphysical movement, means for reporting on the information obtained fromthe means for detecting physical movement, and means for selecting theplurality of sensory signals prior to performing a test on a patient.

In another aspect of the present invention, an apparatus for performingneuropsychological tests on a patient comprises a microprocessing unitadapted for carrying out test procedures, said microprocessing unitbeing connected to:

an interface to a sensory signal generating device comprising at leastone of a visual information display, an indication light, and a soundgenerator;

an interface to a reaction detecting device comprising at least one of adynamometer, a knob, and a touch screen; and

an interface to a memory for reading test procedures stored in thememory,

wherein at least one test procedure comprising instructions for thegeneration of sensory signals and the detection of a patient reaction isstored in the memory and is performed by generating the sensory signalson the sensory generating device and by detecting a patient's reactionthrough the reaction detecting device.

Advantageously, the memory is an internal memory of the apparatus. Inthe alternative, the memory may be a card or a set of cards, in whichcase the apparatus may comprise a card reading device for insertion andreading of the card or cards. In another embodiment, the interface to amemory is an interface to a computer or a network of computers whichcomprise the memory.

Advantageously, the microprocessor is connected to an interface to areporting device for reporting information on reactions detected throughthe reaction detecting device. This interface to a reporting device maybe to a printer, or to a computer or a network of computers, or both.

The sensory signal generating device may comprise one or several among asound generator which may be a headset, one or a plurality of indicationlights which may be of different colors. The reaction detecting devicemay comprise one or several among a dynamometer which may be a handgrip, a knob which may be a push button, a rotary switch, or acombination push button and rotary switch. Specifically, the sensorysignal generating device advantageously comprises an information displaydevice, an indication light, and a sound generator, and the reactiondetecting device advantageously comprises a touch screen, a dynamometerand a knob.

In an embodiment of the apparatus of the present invention, a pluralityof sensory signals are generated simultaneously, and in particular,visual and audio signals may be generated simultaneously. Also, aplurality of physical reactions of the patient are advantageouslydetected during the performance of the test procedure.

An advantage of the apparatus of the present invention is that a muchmore extensive evaluation of neurocognitive areas of patients can beobtained than with currently known apparatuses. For example, it may bepossible to evaluate impairments in neurocognitive areas using one orseveral of the following measures:

-   -   Response to multi-sensory stimuli    -   Ability to perform a repetitive motor task with and without        outside auditory or visual distraction    -   Grip strength, persistence and side variability    -   Cognitive perceptual competence and memory    -   Performance in tracking through a series of increasingly complex        patterns

These assessments may be used to identify who may be suffering from suchdisorders as senile dementia, Alzheimer's disease, attention deficitdisorder, post-traumatic cognitive and neurological disabilities,impairment in perceptual-motor function reflecting an inability toperform motor tasks such as driving, and/or other activities requiringeffective motor performance.

Another advantage of the apparatus of the present invention is that itmay be possible to carry out a wide variety of neuropsychological testsusing a single unitary, compact, and portable instrument which is veryeasy to use.

BRIEF DESCRIPTION OF DRAWINGS

FIG. 1 is a top view of an embodiment of an apparatus according to thepresent invention;

FIG. 2 is a lateral view of the apparatus of FIG. 1;

FIG. 3 is a back view of the apparatus of FIG. 1; and

FIG. 4 is a block diagram of the apparatus of FIG. 1.

DETAILED DESCRIPTION OF THE INVENTION

The example of apparatus according to the present invention which isshown in FIG. 1 comprises a casing 1 having a generally rectangularblock shape except that a front face 2 comprises a slanted portion 3.Visual signal generating means in the form of a LCD screen 4 and lights5, 6 and 7 are located on the front face. Audio signal generating meansin the form of a headset 8 is connected to an audio interface 9 on thefront face of the apparatus. Reaction detecting means is present in theform of a touch screen 10 and a knob 11 located on the front face and adynamometer 12 connected to a dynamometer interface 13.

In this embodiment, as shown in FIG. 4, the LCD screen 4 is associatedto the touch screen 10 to form a display unit which functions both asdisplay means to display information on the display unit and as reactiondetecting means to detect actions by a user on the touch screen. Thetouch screen 10 is connected to a touch screen controller 14.

The knob 11 is adapted to detect tapping by a finger. For example, theknob may be a simple switch which is movable between off and onpositions by pushing. In that case, only the on or off position of theknob is detected. In this embodiment, the knob is rotatable around acentral axis. In that case, both the on or off position and the angularposition of the knob are detected.

The dynamometer 12 is a hand grip which is connected to the interface 13comprising an analog/digital converter 15. The hand grip comprises ahandle portion and is adapted to detect the grip strength of a patient.Specifically, the grip handle comprises two mutually connected handleportions which are movable between a first position away from each otherand a second position close to each other, and resilient means (notshown) such as a spring which tends to force the handle portions awayfrom each other. The relative position of the two handle portions isdetected electronically so as to provide an information on the gripstrength. Optionally, the grip may also comprise a switch button.Examples of such grips are known and used in particular in electronicgames. In an alternative embodiment, the hand grip could be mounted onthe casing. In that case, the hand grip could be a foldable grip.

Advantageously, various grips adapted for measuring different grippingstrengths can be successively mounted on the machine, such as a grip forchildren and a grip for adults. Also, the apparatus may comprisesseveral different or similar grips.

As shown on FIG. 4, the headset 8 is connected to the interface 9 whichcomprises stereo audio faders and mixing amplifiers 16 and a record/playsound chip 17. The sound generator thus constituted can generate true,sampled sounds which may be prerecorded and preloaded into theapparatus, or may be modified as part of the modification of a testprocedure.

As shown on FIGS. 3 and 4, the apparatus also comprises an interfaceport 18 associated with a modem 19 for connection to a network ofcomputers for communication and modifications of test procedures, testresults, or both, an interface port 20 associated with a printerinterface 21 for connection to a printer for printing test procedures,test results, or both, an interface port 22 associated with a PCinterface 23 for connection to a personal computer for communication andmodifications of test procedures, test results, or both, and aninterface port 24 associated with a power regulator 25 for connection toa source of electrical current. In addition, a separate interface portfor connection to a network could be provided.

Further, the apparatus comprises a memory card interface port 26associated with a memory card interface 27, which are adapted to receiveand connect to external memory cards such as memory card 28 for storingtest procedures, test results, or both.

As shown on FIG. 4, inside the casing is disposed a central processingunit (CPU) 29 which is adapted to sequentially perform the testfunctions, including executing memorized or detected instructions andprocessing corresponding information. The CPU is connectedelectronically to each of the visual and audio display means so as toprovide appropriate display signals to these display means, to thereaction detecting means so as to detect, collect and processinformation on the patient's reactions, and to the interface ports. TheCPU is also connected to static RAM operating memory 30 and real-timeclock 31 for providing time and date, as well as an EEPROM 32 forstoring user configuration and modifications, and a flash program datastorage memory 33 for storing test procedure files received from anexternal source, such as a computer or a network of computers, as wellas test results.

The CPU thus controls means for generating sensory signals adapted to bedisplayed on the sensory signal generating means, and means fordetecting, analyzing and processing detection signals adapted fordetecting, analyzing and processing signals generated by the reactiondetecting means.

During a test, the CPU executes instructions by controlling thegeneration of sensory information directed to the patient, such asvisual information or auditory information on the sensory display means,and detecting, analyzing and processing information on the patient'sreaction from the reaction detecting means.

Specifically, the apparatus shown in FIGS. 1-4 functions as follows. Theapparatus is adapted to administer to a patient a series of neurologicaltests designed to measure neuro-cognitive functions. More particularly,tests are designed to identify whether or not an individual is impairedin one of a series of activities which are characteristically identifiedas reflecting impairment or adequacy of performance in areas ofneuro-cognitive activity. Tests may be administered alone or in sequenceof several tests. In a sequence, tests may be administered in any order.The test instructions and the test sequence is preferably prerecorded inthe memory of the apparatus or in a card. However, a choice betweenseveral test sequences, or a choice between individual tests in a testsequence, may be available, for example by displaying visual prompts onthe screen and detecting a user's response on the touch screen. Also,the test sequences may be selected or modified from a remote location,such as from a computer.

When the apparatus is connected to a power source, the screen lights upand a visual indication is displayed on the screen requesting a user toenter personal data such as name, address, age, and then, press a starticon on the touch screen to start testing. When the patient touches thetouch screen, a corresponding signal is received by the CPU and the testor the sequence of tests is started. The patient is then directed tofollow directions on display on the screen or audio instructionscommunicated through the headset. Each test performed, either alone orin a sequence, may be selected from the following tests, or from othertests also made available in the apparatus. In the following, examplesof tests which can be performed on the apparatus are described.

A first test is adapted to measure abstract reasoning ability and visualmemory. A number of shapes forming a first pattern are shown on thescreen for a fixed period of time. The screen is then cleared and acomparative pattern comprising the same number of shapes is flashed onthe screen. The patient is asked to identify whether the comparativepattern is the same or different as the pattern shown previously. Forexample, the shapes are triangles, each having a pointer indicated by ablocked point of each triangle in a specific series of directions. Thepatient is thus called upon to recognize whether the pattern ofdirectional pointers is the same or different. A portion of the screenis reserved for gathering the patient's reaction. Thus, a question isdisplayed on the screen, with a “yes” portion and a “no” portion, andthe patient's response is detected by detecting whether the patientpresses the corresponding portion of the touch screen.

Next, an increased number of shapes forming a second pattern isdisplayed on the screen for a second fixed period of time which may bethe same as the length of the previous pattern or different. Forexample, the new pattern can comprise four triangles instead of three,each triangle also with pointers in specific directions. The pattern isthen cleared, a second comparative pattern is shown on the screen, andthe patient's reaction is detected.

A succession of such procedures is performed and the patient's reactionsare detected. The number of such procedures, the length of time ofdisplay, the presentation of the patterns and the comparative patternsare pre-programmed in the apparatus, or the apparatus is adapted forprogramming these features prior to carrying out the test, for examplethrough prompts on the touch screen.

A second test is adapted to measure a patient's ability to changedirections with a visual symbol acted out in a motor activity, i.e., tomeasure visual motor perceptual accuracy of performance and responsetime for performing a basic motor task. A first maze design is displayedon the screen and the patient is asked to trace with the finger throughthe maze on the touch screen. The time for performing this task and thenumber of errors are detected. This sequence is repeated with a secondmaze, a third maze, etc., which become more and more complex.

A third test is adapted to measure the ability to track a moving target.A visual target which moves randomly in the transverse direction of thescreen is displayed on the screen, and the patient is asked to align apointer with the target by rotating the knob to the right or to theleft. The shape, trajectory and speed of the target may be fixed or mayvary during the test.

A fourth test is adapted to measure consistency of effort level and handgrip strength on the right and left side. A visual or audio squeezesignal is displayed, and the patient is asked to squeeze the grip whenthe squeeze signal is displayed. The grip strength is detected. Thenumber and the type of squeeze signals may vary during the test. Forexample, the patient may be asked to squeeze with the left or righthand, a given number of time, for a given length of time, with a givenstrength, etc.

A fifth test is adapted to measure finger tapping. This test is used tomeasure neuro-cognitive and neuropsychological deficiencies. A visual oraudio tapping signal is displayed, and the patient is asked to tap theknob for a given length of time. For example, a visual instruction isdisplayed on the screen, a start and stop sounds are displayed throughthe headset, and the timing and number of taps are detected. Thedetected information can be processed by the CPU, for example bycomparing the test results with pre-recorded standard normalperformances.

A sixth test is adapted to measure the ability to follow directions of asimple visually directed motor skill task. A first pattern of shapes isdisplayed on the screen, and the patient is asked to press the knobsuccessively to have the shapes disappear one after the other. Then, asecond pattern, a third pattern, etc., are displayed, and the patient'saction on the knob is detected.

A seventh test is adapted to measure physical response to a visual orauditory stimulus. A visual signal such as a simple drawing is displayedon the screen, and the patient is asked to press the knob as soon as thedrawing is seen. In the alternative, an audio signal such as a beepingsound is given through the headset, and the patient is asked to pressthe knob as soon as the signal is heard. The patient's action on theknob and the time delay between the signal and the action on the knobare detected. For example, the drawing is a simple line, or consists ofa series of words or letters. The audio signal is given to the left ear,the right ear, or both ears. The number of trials and the type ofsignals can vary during the test.

In each of the tests, an additional factor can be incorporated in thatvisual and/or auditory distraction can be presented to the patient. Forexample, distracting patterns can be displayed on the screen, ordistracting sounds can be performed in the headset, or both.

For each of the tests, the test procedures are pre-programmed in theapparatus, or the test procedures can be modified by a user eitherdirectly from the touch screen or by changing cards, or through anexternal computer or network of computers. The tests can be adapted toparticular objectives or uses. For examples, individual features of eachtest, such as the type of visual or audio signals and the type ofpatient's action which is detected, can be modified. Also, individualfeatures of the above tests can be combined to form new tests. The testprocedures described above are given only as examples, and other testprocedures may be used in addition or in place of these examples.

In alternative embodiments of the present invention, the apparatusassociates other combinations among the components of the sensory signalgenerating means and reaction detecting means which have been describedin connection with FIGS. 1-4, or comprise additional components. Any ofsuch components is mounted on the apparatus or may be connected to theapparatus through a wire connection or other communication device.

1. Apparatus for performing neuropsychological tests on a patient,comprising: means for generating a plurality of sensory signalscomprising visual signals, auditory signals, or both visual and auditorysignals; means for determining perceptual-motor function in aneuropsychological test by detecting physical movement of a patient inresponse to said generated plurality of sensory signals, said detectedphysical movement comprising at least one of (i) the trajectory or speedof a rotating motion of a rotary knob turned by the patient and (ii) theaccuracy of a path traced by the patient on a touch screen; and meansfor reporting information on the detected physical movement of thepatient through an interface to a computer or network of computers, orboth.
 2. Apparatus according to claim 1, wherein the plurality ofsensory signals is determined prior to performing a test on a patient.3. Apparatus according to claim 1, wherein visual signals and auditorysignals are simultaneously generated.
 4. Apparatus according to claim 1,further comprising means for storing, processing, or both storing andprocessing information obtained from the means for detecting physicalmovement.
 5. Apparatus according to claim 1, wherein said detectedphysical movement comprises the trajectory or speed of a rotating motionof the rotary knob turned by the patient.
 6. Apparatus according toclaim 1, wherein said detected physical movement comprises the accuracyof a path traced by the patient on the touch screen.
 7. The apparatus ofclaim 1, wherein the information is reported through a network ofcomputers.
 8. The apparatus of claim 7, wherein the information isreported through a modem.
 9. The apparatus of claim 1, wherein the testprocedure is selected or modified from a remote location.
 10. Apparatusfor performing neuropsychological tests on a patient, comprising amicroprocessing unit adapted for carrying out test procedures, saidmicroprocessing unit being connected to an interface to a sensory signalgenerating device comprising at least one of a visual informationdisplay, an indication light, and a sound generator; an interface to areaction detecting device for determining perceptual-motor function in aneuropsychological test, said reaction detecting device comprising atleast one of (i) a rotary knob that measures the trajectory or speed ofa rotating motion of the rotary knob turned by the patient and (ii) atouch screen that measures the accuracy of a path traced by the touchscreen; and an interface to a memory for reading test procedures storedin the memory, wherein at least one test procedure comprisinginstructions for the generation of sensory signals and the detection ofa patient reaction is stored in the memory and is performed bygenerating the sensory signals on the sensory generating device and bydetecting a patient's reaction through the reaction detecting device,and and interface to a computer or network of computers, or both,wherein information on reactions of the patient detected through thereaction detecting device is reported to the computer or network ofcomputers or both.
 11. Apparatus according to claim 10, wherein thememory is an internal memory of the apparatus.
 12. The apparatus ofclaim 10, wherein the reaction detecting device comprises the rotaryknob adapted to detect the trajectory or speed of a rotating motion whenturned by the patient.
 13. The apparatus of claim 10, wherein thereaction detecting device comprises the touch screen adapted to detectthe accuracy of a path traced by the patient.
 14. The apparatus of claim10, wherein the sensory signal generating device comprises aninformation display device, an indication light, and a sound generator.15. The apparatus of claim 10, wherein the reaction detecting devicecomprises the touch screen, the rotary knob, and a dynamometer.
 16. Theapparatus of claim 10, wherein the information is reported through anetwork of computers.
 17. The apparatus of claim 9, wherein theinformation is reported through a modem.
 18. The apparatus of claim 10,wherein the test procedure is selected or modified from a remotelocation.
 19. A process for performing neuropsychological tests on apatient, comprising: generating a plurality of sensory signals comparingvisual signals, auditory signals, or both visual and auditory signals;determining perceptual-motor function in a neuropsychological test bydetecting physical movement of a patient in response to said generatedplurality of sensory signals, said detected physical movement of apatient in response to said generated plurality of sensory signals, saiddetected physical movement comprising at least one of (i) the trajectoryor speed of a rotating motion of a rotary knob turned by the patient and(ii) the accuracy of a path traced y the patient on a touch screen; andreporting information on the detected physical movement of the patientthrough an interface to a computer or network of computers, or both. 20.Process according to claim 19, further comprising assessing the reportedinformation to identify whether the patient is suffering from at leastone disorder selected from senile dementia, Alzheimer's disease,attention deficit disorder, post-traumatic cognitive and neurologicaldisabilities, impairment in perceptual-motor function.
 21. Processaccording to claim 20, comprising assessing the reported information toidentify whether the patient is suffering from Alzheimer's disease. 22.Process according to claim 20, comprising assessing the reportedinformation to identify whether the patient is unable to drive.
 23. Aprocess for performing neuropsychological tests on a patient,comprising: generating a plurality of sensory signals comparing visualsignals, auditory signals, or both visual and auditory signals;determining perceptual-motor function in a neuropsychological test bydetecting physical movement of a patient in response to said generatedplurality of sensory signals, said detected physical movement of apatient in response to said generated plurality of sensory signals, saiddetected physical movement comprising at least one of (i) the trajectoryor speed of a rotating motion of a rotary knob turned by the patient and(ii) the accuracy of a path traced y the patient on a touch screen; andreporting information on the detected physical movement of the patientthrough an interface; and assessing the reported information to identifywhether the patient is suffering from at least one disorder selectedfrom senile dementia, Alzheimer's disease, attention deficit disorder,post-traumatic cognitive and neurological disabilities, impairment inperceptual-motor function.
 24. Process according to claim 23, comprisingassessing the reported information to identify whether the patent issuffering from Alzheimer's disease.
 25. Process according to claim 23,comprising assessing the reported information to identify whether thepatient is unable to drive.